CN1126430A - Apparatus for the closure of wide skin defects by stretching of skin - Google Patents

Abstract

The invention relates to a device which adopts two skinning needles that are designed to be inserted into skin to neighbor damaged edges of skin so as to close a wide damage part of skin. The invention consists of two motion-limiting parts which are designed to form a U-shaped flange and to connect two legs. Each leg consists of a spiky hook or an obtuse skin inserting part at the end for penetrating into skin and to be jointed with one skinning needle. The motion-limiting part consists of a local jointing part which is partially jointed with the needles positioned on the upper part of the skin surface. A shrinking mechanism can connect with the motion-limiting part and to close and fold the damaged edge of skin.

Description

The device of closure of wide skin defects by stretching of skin

Present patent application is that the part of U.S.'s design application number 29/003751 of the Application No. 08/055413 of 3 days Mays in 1993 applications of present pending trial and Decembers in 1992 application on the 3rd of pending trial at present continues, and Application No. 08/055413 is that the Application No. 07/835636 of application on February 13rd, 1992, the part of present U.S. Patent number 5263971 continue.

The present invention relates to a kind of stretching of skin with the device that an open wound covers, be specifically related to a kind ofly be used for before operation or the closed skin injury of operation process and make the device of the unlikely damage of skin area.

United States Patent (USP) has disclosed for No. 4896080 and a kind ofly by cyclic loading skin has been stretched over method and apparatus above the wound.Several periods can interrupting between by relaxation period, on relative skin edge, apply a power, skin is stretched over a broad area.A surgery extending apparatus according to this patent can comprise along two pins in the two edges insertion skin of wound.

Can two pins be pulled in together gradually with a flexible strip.Tension force on the pin or drag load can be interrupted and apply, so that the gtelatinous fibre of skin rearranges to do further stretching, extension.This pin can be configured as substantially a safety needle that is loaded on the annular distance of flexible strip.Band can comprise the perhaps many apertures of many projectioies of using with a ratchet-like means for engaging.This ratchet-like device can be strong and configuration state grip this pin.

The shortcoming of said apparatus is in that pin to be pulled in a time-out the most obvious, because be provided with the place or the space is come the skin edge of being drawn close has been sewed up.Another less than two is outer to be that the pin mode of drawing close is quite original, is manually to draw flexible strip, can't continuously control pulling force.Another shortcoming is two pins just fasten relative narrower along two edges two skins, therefore can not once stretch operation just with a broad wound closure.

Therefore need a kind of by once stretching a skin closure or the skin extending apparatus that operation can make broad skin injury closure.Further also needing a kind ofly provides vision or audible indication, and can limit the skin closure device of the size that is added to power on the edge of wound by throwing off a clutch mechanism the tension force that is added in edge of wound or pulling force in stretching process.

The object of the present invention is to provide a kind of skin extending apparatus that two relative edge's edge of one wound are drawn close by a skin stretching, extension operation, this device provides the vision or the audible indication of to some extent afterburning size, and the size of the power that is added to edge of wound is limited.

Skin closure apparatus features of the present invention is, comprise: pin between two edge of wound that the edge need be closed, two skin skins below the insertion skin, include an end face and be used for two retainers near a bottom surface of placed, and at the sharp-pointed hook at the end place of each shank of retainer lower surface.Also can provide a contracting mechanism, be used to spur and draw close two retainers that band extends to the shank of an open wound.The skin extending apparatus can comprise that also the clutch mechanism that prevents this device over-tension and indication are applied to the power of edge of wound, and also indicate a vision and the audition mechanism of cutis laxa.

Retainer can be placed on the back with respect to pin between wound site and aligned relatively skin.The hook of retainer can be along penetrating into skin on the position of edge of wound,, and pin engages between the skin skin that matches with.Contracting mechanism can be designed to retainer at leisure, little by little is pulled in together, therefore can not cause damage skin area.Each retainer can comprise a U-shaped profile so that the skin suture edge, and because two shank both sides and open space is arranged therebetween, the skin closure device is still in the position of approaching wound.

An embodiment of contracting mechanism comprises two parallel alignments, the constrictor arm that also connects by a screw mechanism, can two parts be drawn close at leisure or be pooled together by rotation screw mechanism.One end of each constrictor arm can be designed to be suitable for vertebra and move a rod of the smooth neat cross section of having of a retainer, so retainer is kept relative aligning substantially along the wound both sides, but allow each retainer along its separately rod member move.

Smooth shaft conjugate foramen by on the constrictor arm relevant position of two arms of band parallel alignment can couple together two constrictor arms at its other end slidably.Each retainer comprises two shanks, has bandy hook on the bottom surface of each shank one end; And the flange of vertically boring a hole by one on the smooth shaft that is slidably mounted on the constrictor arm is connected.

Pin between two skin skins can be inserted skin near mouthful edge.The skin closure device is striden across wound place, so just retainer can be placed on the back of skin edge.But the hook pressurized of retainer engages by pin between skin and skin.Rotatable screw mechanism slowly pools together constrictor arm and appended retainer or draws close.Can proceed operation by above-mentioned patent compartment of terrain.

Second embodiment of this device also comprises two U-shaped retainers, and they have the crooked forward hook that is contained in respective end shank bottom side.According to this embodiment, each U-shaped retainer includes a flange connector that is attached on each shank.Can protrude the bead that defines a hole from an end face of flange connector.A bead hole can comprise that one is used to engage the screw thread of a rotatable screw, and this screw is used for drawing close when pin pools together between with retainer and skin skin the U-shaped retainer.

The preferable feature of second embodiment is to comprise a screw thread retainer, and a smooth hole retainer and a screw, this screw at one end have an axle sleeve in order to engaging with smooth hole, and the screw thread on its remaining length is in order to engage with the screw thread retainer.Compare with first embodiment, the shortcoming of second embodiment is the obstacle that is caused by screw position, may hinder or stop the stitching of wound area between two shanks.

In further embodiments, the skin insert can use ring, clip or seam to replace, and perhaps the end of shank itself is designed to an aperture or groove, can make pin local engagement between the skin skin by the skin closure device like this.According to this embodiment, pin between the skin skin can be compiled those visible parts of skin, and can be with one or more local engagement of various local engagement parts.The advantage of the relative prior art of present embodiment is owing to the observability of pin between the skin skin, need not to repeat to penetrate into skin by the skin insert and can finish joint.And because the character of local engagement part, joint can be more firm, and reduce the potential possibility that the local engagement part is thrown off from pin between the skin skin in the skin injury closing course.

In another embodiment, can on the fixed stop of skin closure device and removable retainer, load onto rotary type pedestal or needle stand.When relative edge of wound was not parallel to each other mutually, the rotary type needle stand promptly was adjusted to the geometric position of wound automatically.

In another embodiment, the skin closure device can comprise and is positioned at two dismountable needle stands on the parasystole device arm.Dismountable needle stand can comprise the female connector of a band telescopic locking little protuberance at least, move this female connector and make it subsequently with relative needle stand on a relative outconnector joint.After two relative needle stands are locked together, can remove two parasystole arms and screw thread tension rail, and wound still remains closed, so just improved passage and the observability that is used for the skin suture edge and be positioned at outconnector and female connector between the suturing ability of needle stand central area.

According to the skin closure device of another embodiment, skin insert system is placed in the needle stand, so in case the skin insert is inserted skin, their scalable location.The major advantage that scalable skin penetrates into the part position to be provided is can clamp skin to penetrate into cell tissue between part and needle stand, thereby breaks away from skin in case avoid making pin to rotate when applying big stretching force.When edge of wound is drawn close, skin must be penetrated into part and adjust to a forward facing position so that with the skin edge close proximity for stitching.

The skin closure device of another embodiment is by providing one to be contained in the flexible protective cover on each retainer and the skin that is positioned at close mechanism one side is penetrated into part automatic protection is provided.When pin and protective cover are pressed to skin, the finishing of cell tissue near promptly accusing, consequently protective cover exposes pin to top offset automatically, and pin can penetrate cell like this.Protective cover installs not the time spent at this and can protect user not run into the pin that exposes, and then returns automatically when device engages with skin surface.

The skin closure device of other embodiment is provided for the hand gear of the pin that exposes on the protecting skin closing device.The major advantage that realizes as the result of these devices is that the protection user is not run into the pin that exposes.

The skin closure device of another embodiment comprises that one is used for engaging and unclamping the movable rotary type lock that ends part from screw mandrel or tension rail.This lock and coaxial joint of screw thread tension rail by its longitudinal axis.This lock makes the screw thread tension rail can be mobile a little on its axis, thereby realizes the self-aligned of lock.

Can provide other contracting mechanisms that two retainers are drawn close.Should understand further that main advantages of the present invention is that the shape of two retainers can make still sew up wound edge in the original place and under continuing the situation of pull wound edges toward one another of skin closure device.

The object of the present invention is to provide a kind of can be at extending apparatus skin suture edge and the skin that do not influence suture operation stretches or closing device under the original position situation.

Another object of the present invention is to make that pin can be suitable for clamping substantially whole wound length between the skin skin that inserts skin edge, or extension means can make along edge of wound mobile, and pin engages at diverse location between skin.

Another purpose of the present invention is that needle set has reusability or random usability between this device of permission and skin.According to one object of the present invention, provide a kind of can be at the device that is used for being sterilized, being reused for then behind the patient another patient.According to alternative second purpose, provide a kind of and have limited reusability, can on same patient, use device repeatedly.Alternative the 3rd purpose provides a kind of device that can dispose after once using.

Another object of the present invention provides that a kind of exposed portions serve that makes pin between local engagement part and the skin that inserts along edge of wound engages and the local engagement part does not penetrate into the skin extending apparatus of skin surface.

Another purpose of the present invention is to allow the needle stand or the pedestal of skin extending apparatus to pivot, and makes device can be adjusted to the mutual uneven situation of wound two relative edge's edge.

Another object of the present invention provides a kind of skin extending apparatus, it can according to edge of wound fully draw close will device a part remove, be used to sew up wound to allow bigger passage and observability by skin extending apparatus enclosing region.

Another purpose of the present invention provides and prevents that user is not because of noting being stabbed out by the skin insert that exposes the device of skin.

Introduce embodiments of the invention below in conjunction with accompanying drawing, in the hope of more specifically understanding purpose of the present invention, characteristics and advantage.

Simple declaration for accompanying drawing.

Fig. 1 represents to be positioned at the vertical view of skin closure device first embodiment of the present invention of an open skin wound top.

Fig. 2 represents this device part sectioned view along 2-2 line among Fig. 1.

Fig. 3 represents this device part sectioned view along 3-3 line among Fig. 1.

Fig. 4 represents this device side view along 4-4 line among Fig. 1.

Fig. 5 represents the vertical view of skin closure device second embodiment of the present invention.

The side view of the band part section of Fig. 6 presentation graphs 5 devices.

Fig. 7 represents the axonometric chart of skin closure device the 3rd embodiment of the present invention.

The side view of Fig. 8 presentation graphs 7 devices.

The vertical view of Fig. 9 presentation graphs 7 devices.

The front view of Figure 10 presentation graphs 7 devices.

The rearview of Figure 11 presentation graphs 7 devices.

Figure 12 represents the vertical view of skin closure device the 4th embodiment of the present invention.

Figure 13 represents the profile of Figure 12 device.

Figure 14 represents a clutch vertical cross section of Figure 12 device.

Figure 15 represents a retainer vertical cross section of Figure 12 device.

Figure 16 represents the vertical view of skin closure device the 5th embodiment of the present invention.

Figure 17 represents the side view of Figure 16 device.

Figure 18 represents the front view of Figure 16 device.

Figure 19 represents the vertical cross section of skin closure device the 6th embodiment of the present invention.

Figure 20 represents the profile of Figure 19 device.

Figure 21 represents the vertical view of Figure 19 device band part section.

Figure 22 represents the front view of Figure 19 device band part section.

Figure 23 represents a clutch vertical cross section of Figure 19 device.

Figure 24 represents the screw mandrel that installs among Figure 19 or the partial side view of tension rail.

Figure 25 represents the screw mandrel of Figure 24 or another partial side view that tension rail turns over 90 °.

Figure 26 represents the enlarged drawing of screw mandrel shown in Figure 25 or tension rail one end.

Figure 27 represents the screw mandrel of Figure 25 or an end view drawing of tension rail.

Figure 28 represents the three-dimensional exploded view of another structure of a clutch of Figure 19 device.

Figure 29 represents a clutch vertical cross-section figure of Figure 28 device.

Figure 30 represents the vertical profilograph of the clutch of Figure 28 device.

Figure 31 represents the profile of the clutch of Figure 30 device along the I-I line.

Figure 32 represents the right view of the clutch of Figure 30 shown device.

Figure 33 represents the front view of the knob of Figure 19 device.

Figure 34 represents the vertical cross section of knob among Figure 33.

Figure 35 represents the side view of skin closure device the 7th embodiment of the present invention.

The stereo amplification figure of the frame piece of Figure 36 (a) expression Figure 35 device, it comprise as shown in the figure with a skin between the local engagement part that engages of pin.

The enlarged side view of the frame piece end of Figure 36 (b) expression Figure 35 device, it comprises the local engagement part of second kind of structure.

The enlarged side view of the frame piece end of Figure 36 (c) expression Figure 35 device, it comprises the local engagement part of the third structure.

The enlarged side view of the frame piece end of Figure 36 (d) expression Figure 35 device, it comprises the local engagement part of the 4th kind of structure.

Figure 37 represents the axonometric chart of pin between the skin closure device of eighth embodiment of the invention and skin.

Figure 38 represents the top plan view of the needle stand of Figure 37 device, and shows along pin between edge of wound joint skin.

Figure 39 represents the axonometric chart of ninth embodiment of the invention skin closure device.

Figure 40 represents the side view of Figure 39 device, and it shows that needle stand locks together and throws off from the device retainer.

Figure 41 represents the amplification plan view of device needle stand when locked position among Figure 39.

Figure 42 represents the enlarged side view of device needle stand when locked position among Figure 39.

Figure 43 represents the axonometric chart of tenth embodiment of the invention skin closure device.

Figure 44 represents the enlarged side view of the movable stop of Figure 43 device.

Figure 45 represents the amplification top plan view of the needle stand of Figure 43 device.

Figure 46 represents the Zoom Side profile of the needle stand of Figure 43 device.

Figure 47 represents the amplification stereogram of the needle stand of another embodiment of the present invention, and it comprises a skin insert protective cover.

Figure 48 represents the side view of Figure 47 device.

Figure 49 represents the side view of Figure 47 device, and it shows the situation that skin surface engages with the protective cover of returning.

Figure 50 represents the enlarged side view of a retainer of skin closure device of the present invention, and it comprises that one manually locks Needle shield.

Figure 51 represents the side view that installs among Figure 50, and its manual locking Needle shield is at retracted position.

Figure 52 represents the axonometric chart of Figure 50 device.

Figure 53 represents the amplification stereogram of the present invention's one retainer, and it comprises the rotatable part of another embodiment.

Drawing in side sectional elevation when Figure 54 represents that locking member is shown in an open position in Figure 53 device.

Drawing in side sectional elevation when Figure 55 represents that locking member is in the closed position in Figure 53 device.

Figure 56 represents the vertical view of pin between the skin skin of another embodiment among the present invention.

Figure 57 represents among Figure 56 the part sectioned view of pin between the skin skin.

Figure 58 represents the vertical view of apparatus of the present invention band protective cover.

Figure 59 represents the profilograph of the protective cover that installs among Figure 58.

Figure 60 represents the vertical view of compensator among the present invention.

Fig. 1-4 expression skin closure of the present invention or skin extending apparatus.Skin closure device 10 can pin I, I ' use with between two skin skins.As depicted in figs. 1 and 2, pin all can have a head 1 between every root bark skin, and can be below edge of wound is inserted into skin.The skin closure device can comprise two retainer II, II ' that are used to engage one of pin between two skins.

Each retainer is the U-shaped profile, and with two parallel shanks that separate again 20 that flange 21 connects, flange 21 has defined the longitudinally guiding hole 22 that is preferably the square-section.A plurality of each hook 23 that extends forward all can be connected to below the retainer.Each hook that extends forward all can be located in the end of the shank 20 of retainer.

Hook end segment is preferably sharp point, can penetrate into skin, and with from engaging away from pin between a root bark skin of wound one side.Retainer passes through two constrictor arm III, III ' location, and is slidably mounted in shaft-like end 30 along rectangular opening 22.A cylindrical bar 31 parallel alignment that the constrictor arm can extend by the lateral aperture in the bead 32 of passing this constrictor arm other end are fixed.

Screw I V can be pulled in two constrictor arms together, also can open by the screw in bead 33 on the arm III end face, and can by bead 33 on arm III ' end face ' in unthreaded hole further open.Screw I V can expose an end of thread 40, be contained in handle or handle 42 on the screw I V with an axle sleeve 41 of bead 33 ' applying of constrictor arm III ' and by flexible pipe or helical spring 43.By turning handle 42, with the end of thread of threads engage in the bead 33 can be with arm III, III ' pulling mutually, pin I, I ' wound contraction edge between retainer II, II ' on the arm are then by hook 23 and skin.

As described in No. the 4896680th, United States Patent (USP), skin closure operation can divide several stages to carry out, so that skin stretches in mode gradually in the interval in the stage of stretching, extension.After skin injury or edge of wound are pulled to contact, can be by the mode sew up wound of prior art; Obviously shank 20 does not influence operation, because it is away from edge of wound.

The skin closure device 10 of Fig. 5 and 6 expressions, second embodiment '.Retainer 5,5 ' drawn close by screw 6.Retainer is roughly similar to the retainer among Fig. 1 and 2, on its corresponding end face, have two the perforation beads 51,51 '.Bead 51 can define a tapped through hole, bead 51 ' then can define a smooth through hole.

Screw 6 comprises an end of thread 61, it with the bead 51 of retainer 5 in be threaded, a smooth part (not shown) is in bead 51 ' middle rotation, an axle sleeve 63 nestle up bead 51 ', and the operating portion 64 of a flexibility, its terminal is leader or handle 65.The contraction of skin operation is described similar with the foregoing description, but 6 pairs of suture operations of screw have obstruction slightly.

The 3rd embodiment 10 of Fig. 7～11 expression skin closure devices ".Wherein 70,70 ' and be retainer, screw 82 applies the skin pulling force.This embodiment also can use two to insert skins with along pin between the skin skin of edge of wound distribution closing force.The pin biggest advantage is the uniform distribution of power on large area skin between skin.Retainer 70,70 ' on four shanks 20 be connected with skin insert or hook 23 respectively, they skin stretch in the operation process with the skin skin between pin engage.

Retainer 70 can be designed to afterburning retainer, and is the U-shaped profile.Retainer 70 ' then can be placed on the opposite of skin injury retainer 70 on one side also can be the U-shaped profile.And can provide the contracting mechanism 80 that retainer is drawn close.

Contracting mechanism can comprise a big knob 81 that is used for reinforcing and can be placed on close retainer 70 places.This knob can comprise that many groove 81a and/or many flange 81b (seeing Figure 17) are so that the user operation knob.Contracting mechanism also can comprise a screw mandrel or tension rail 82, and it comprises a threaded portion 83a and a thread head 83b.

According to preferred embodiment, screw mandrel has very high rigidity, so crooked minimum along the screw mandrel line.Can adopt the fibrous glass reinforcing material, the high rigidity that this material can provide non-reinforcing material not provide.Preferably adopt politef or siliceous plastic material.The advantage of politef is to provide lubricated, makes screw thread be easy to operation, and has limited hysteresis or amount of friction.

Retainer 70 ' on but regurgitation lock 85 can be arranged, be used for retainer releasably is locked in screw.Lock 85 is useful on bigger half smooth hole that is used to make retainer 70 ' be free to slide along tension rail 82 that defines half screwed hole of being threaded.User is slidably locked 85 and is selected bonding station, and the half-thread hole is engaged with the threaded portion 83a of tension rail.Select free position by slide lock 85, so that half bigger smooth hole is circumferentially located around the threaded portion 83a of tension rail 82.As shown in figure 10, lock 85 also can comprise lock shaft 86 (seeing Figure 15) and retainer 70 ' groove 76 in the lock shaft pin 86a that slides.But the advantage of regurgitation lock is to make user throw off retainer in very fast mode, and retainer is engaged again with screw connection.

Lock has a threaded portion, retainer can be locked together.Resilience by selected materials also can be with the lock biasing, so lock can be parked on the closed or open position.

The 4th embodiment 100 of Figure 12～15 expression skin closure devices, it comprises retainer 70,70 ' and screw 82 that applies the skin pulling force.Also consider when adopting this embodiment and pin between two skin skins can be inserted in the skin, and can be along the edge of wound closing force that distributes.Pin advantage is exactly the uniform distribution of power on large area skin between the skin skin.Retainer 70,70 ' also has skin insert or the hook 23 on each that is connected in four shanks, these shanks skin stretch in the operation process with the skin skin between pin engage.

This embodiment also comprises having rotatable or be contained in the retainer of the pedestal 71 on the axle.As shown in figure 12, sway and preferably reverse about 40 °, promptly around a reference position of retainer from arrestment mechanism or to rotary type pedestal core turn over ± 20 °.

Pivot pedestal 71 is also considered to do 360 ° of whole circumference to rotate.The advantage that rotation or pivot pedestal provide is that this gyration can make device consistent with irregular power, irregular skin movements or irregular edge of wound, with uneven distribution or the device dislocation of avoiding power.The power that the revolution of retainer or pivoting action can make device be obedient to run in the wound closure uneven naturally.

One power level indicator 90 also can be provided.The power that the indication of power level indicator is applied along the skin injury edge by constriction device.The power level indicator can comprise a pointer 92 and adopt colour chart or a scale of the different brackets of the indication institute application of force.

In a preferred embodiment, a target scale is represented the power that is added to the different brackets on the edge of wound as numeral 91.Another kind of subjective digital calibration or colour chart scale also can be provided, and for example green is an inferior grade power, and yellow is a middle grade power, and redness is a high magnitude forces.

Figure 13 and 14 is represented the 4th embodiment, and it comprises a clutch 110 of the power that the restriction contracting mechanism can apply.For the application's purpose, but but but the applicant be defined as a clutch with first revolving meber or be coupling and be incorporated into second revolving meber or axle or its any mechanism, electromagnetism, hydraulic pressure or other device of throwing off from second revolving meber or axle.Correspondingly clutch designs can be become a friction clutch or be contained in coupling spline system and screw mandrel in the handle 81.

One compression spring 88 makes splined shaft 11 enter splined hole 112.By preferred embodiment, this compression spring is designed to when the power that applies reaches about 2.5kg or is higher slightly spline and throws off.

Splined hole can be designed to the groove with the splined shaft shape complementarity, and owing to handle wall defines.When on handle, applying power or moment, this device equipment and travel forward from the indicator of twist grip projection, indicate increasing power just to be applied on the edge of wound.

When skin stretches and those power when reducing, indicator is return to 1 along number of division 4.Screw 82 links together retainer, so pin and retainer take a time-out between with skin, promptly tension force is added on the edge of wound.

Retainer 70 ' also can comprise releasable lock 85 is used for providing one to be threaded to screw.Lock 85 can be designed to the resilient latch with threads engage, and has a resilient structures, to remain on locking or released position.The rebound characteristics of lock and lock shaft pin 86a fixes on locking in the retainer.As shown in figure 15, lock shaft pin 86a can be and a resilient structures that wall engages that defines groove 76.

This embodiment preferably adopts the gamma sterilization to carry out disinfection.Though also can adopt as traditional sterilizations such as ETO.

100 of Figure 16～18 expression skin closure devices the 5th embodiment ', it comprises retainer 79,79 ' and screw 82 that is used to apply the skin stretching force.Can adopt when adopting this embodiment that pin inserts skin and closing force is reached skin between two skin skins.Retainer 79,79 ' also comprises skin insert or the hook 23 that is connected on each shank 20.According to this preferred embodiment, knob has these many flanges or protuberance 81b to strengthen sense of touch, particularly when the doctor wears glove.

This embodiment also comprises the retainer with rotation or pedestal 71 of swaying, and amount of spin preferably rotates about 40 °, promptly from a center or the Herba pteridii latiusculi position turn over ± 20 °.The difference of this embodiment and previous embodiment is that pivot pedestal " wide " adopts multiple arrangement or repeatedly adopts the closed skin area of single device to not needing.

According to the preferred embodiment shown in Figure 12-15, the width of each retainer is between 20 to 40 millimeters.In broad embodiment shown in Figure 16-18, the big width (between 40 to 80 millimeters) of each retainer provides extra stability.These two embodiment preferably adopt the gamma sterilization to carry out disinfection, though also can adopt as traditional disinfection technologies such as ETO sterilizations.

The 6th embodiment 100 of Figure 19-34 expression skin closure device ", the embodiment of it and Figure 12～15 is similar substantially.As shown in figure 21, present embodiment skin closure device comprises the link stopper 72 that restriction pivot pedestal rotates.Present embodiment skin closure device also comprises first and second kinds of tectonic types of a modified model clutch mechanism.Every kind of tectonic type of modified model clutch mechanism all comprises two the static spline 122 and the inclination contact surface 122a that are contained in the knob 81.

According to first kind of tectonic type of modified model clutch mechanism, shown in Figure 23～27, an end of screw mandrel 82 comprises that two of having best angle inclination contact surface 121a at 45 can axially movable spline 121.Screw mandrel 82 and spline 121 can move axially with respect to knob 81.For clarity sake, omitted the threaded portion of screw mandrel 82 in Figure 24～27.When spline engages again, can see the advantage of this clutch in the Dermatochalasia process.Because inclined surface, spline can be aimed at automatically again in original position.Opposite with here modified model clutch, existing clutch in alignment procedures again, as splined shaft and splined hole mutually not centering then can produce the misalignment problem.But asymmetric with the axis of rotation of screw mandrel 82 because of foozle as spline 121, then this modified model clutch also can have problems.In this case, when spline engages in the cutis laxa process again,, thereby clutch is bitten owing to the off-centre dislocation of axle makes spline 121 be configured in the same side of spline 122.Therefore, the necessary very little foozle of corresponding maintenance is to guarantee the axis of rotation balanced configuration of spline 121 around screw mandrel 82.

Figure 28-32 expression is according to skin closure device the 6th embodiment 100 of second kind of tectonic type " the modified model clutch mechanism, this pattern has overcome more inherent problems of clutch mechanism of first kind of pattern.In second kind of pattern, screw mandrel 82 only comprise one single have an inclined contact surface 121a can axially movable spline 121.Enter extending axially in the process of knob at screw mandrel 82, always single spline is no matter how its direction with respect to spline 122 can be engaged in 122 of the splines of knob.And in first kind of pattern, then can be by the turning knob that needs of axle, so that single spline 121 can slide between the knob spline.This allows screw mandrel 82 relative knobs that one off-centre is arranged, and does not have the danger that axially pins down, as shown in figure 30.Consequently screw mandrel can be moved axially in the handle, and the spline 122 of the spline 121 that enough makes other and knob in a full surface engagement.

Figure 33 and 34 expressions are with the enlarged drawing of the knob of static spline 122.Static spline 122 comprises the inclined contact surface 122a that preferably is inclined to the 45 degree.

The 7th embodiment 100 of Figure 35-36 (a) expression skin closure device ", each retainer 70,70 ' include a substrate 71 wherein with a pair of shank 20, each shank comprises a local engagement part again.This embodiment and the previous embodiment of skin closure device are similar, and wherein corresponding part adopts same Part No..Figure 35 and 36 (a) expression is by the local engagement part of first kind of pattern, and wherein the end of each shank 20 can comprise that one is connected to the ring 123 of the bottom side or the end of shank 20.Ring 123 can be made with rustless steel, " Lexan " Merlon or composite fibre materials with various rigid metals or plastics such as surgery.Shown in Figure 36 (a), the exposed portions serve local engagement of pin I, I ' between the skin skin that ring 123 can and insert along the skin injury opposite edges.

Figure 36 (b) expression is by the local engagement part of second kind of pattern, and wherein the end of each shank 20 can comprise that one is connected to the seam 124 of the bottom side or the end of shank 20.Seam can medically be made through the suitable filamentary material of approval with any.Every seam 124 preferred design become an annular.Seam 124 can be by the exposed portions serve local engagement of pin I, I ' between the skin skin that inserts along the skin injury opposite edges.

Figure 36 (c) expression is by the local engagement part of the third pattern, and wherein the end of each shank 20 can comprise that one is connected to the latch closure 125 of the lower surface of shank 20.Latch closure 125 can be made by various semirigid metals, plastics, synthetic material or composite fibre materials.The exposed portions serve local engagement of pin I, I ' between the skin skin that latch closure 125 can and insert along the skin injury opposite edges.Each latch closure include can be reliably with skin between the curve that cooperates of pin I, I ' or concave part 125a and the flexible arm portion 125b that allows user that the skin closure device is thrown off from pin between skin.

Figure 36 (d) expression is by the local engagement part of the 4th kind of form, and wherein the end of each shank 20 can comprise aperture or the groove 126 that is used for accepting one of pin I, I ' between the skin skin.The exposed portions serve local engagement of pin I, I ' between the skin skin that aperture or groove 126 can and insert along the skin injury opposite edges.Each groove comprise have and a skin between pin diameter first circular portion 126 (a) about equally so that accept pin between skin reliably.This groove comprises that also one is connected to first circular portion and comprises the second narrow 126b of an opening at place, the end of shank 20.The end that centers on the shank 20 of narrow 126b has flexibility, can allow user selectively to make the skin closure device throw off pin between skin.

The another embodiment 200 of Figure 37～38 expression skin closure devices, it comprises retainer 70,70 ' and be used for applying a screw mandrel 82 of skin pulling force.Each retainer 2 can comprise a pedestal 128 that comprises a pivot needle stand 130 at least.According to present embodiment, can get on the pedestal that needle stand 130 is fixed to each retainer neatly by traditional means.And can comprising a skin that is fixed on the part of needle stand with any any means known at least, each needle stand penetrates into part 23.Skin penetrate into part 23 be designed to penetrate into skin and with a plurality of skins below the wound opposite edges are configured in skin surface between pin engage.

According to preferred embodiment, can provide a telescopic shaft pin member 132 needle stand is fixed on the pedestal of each retainer neatly.Needle stand 130 and telescopic shaft pin member 132 are configured as integral body with pedestal 128.Telescopic shaft pin member 132 allows needle stand to do the variation of geometric aspects with respect to edge of wound.Like this, when the skin edge that defines wound was not parallel, needle stand 130 can rotate to adapt to the wound actual geometric configuration around telescopic shaft pin member 132.When edge of wound became almost parallel, the rotary type needle stand was promptly adjusted to new geometry automatically.Each needle stand 130 includes a pair of shank that extends internally 134.Each shank 134 includes a skin insert 23 that extends and be connected to the end of shank from the end of shank, and so that a kind of reliable means that the skin closure device is fixedly positioning to be provided, these means can provide best wound closure performance.

The another embodiment 200 ' of Figure 39-42 expression skin closure device, it comprises retainer 70,70 ' and screw mandrel 82 that is used to apply the skin pulling force.Each retainer can comprise again can from skin closure device 200 ' main body rotary type pedestal or the needle stand 136 removed.Each needle stand 136 comprises a locking member that is used for needle stand is locked together (cloudy or sun) at least, and as shown in figure 41, edge of wound promptly allows to take before sewing up and removes the skin closing device, and keep wound closed fully in case draw close fully.Each removable needle stand can comprise that any any means known of a plurality of usefulness is fixed to needle stand skin partly and penetrates into part 23.Skin penetrate into part 23 be designed to penetrate into skin and with a plurality of skins below the wound opposite edges are configured in skin surface between pin engage.

According to a preferred embodiment, each needle stand 136 includes a socket aperture 138 that is contained in the needle stand upper surface.Will each retainer 70,70 ' a double pointed nail 140 of lower surface removably be configured in the socket aperture 138, a releasable connection is provided between its corresponding needle stand of each retainer.Each removable needle stand 136 can comprise along its closed side localized one a whole plug connector 142 and an integral socket formula adapter 144.When edge of wound was drawn over to one's side together, as shown in figure 40, the corresponding resilience female type adapter 144 on each plug connector 142 and the relative needle stand engaged.As shown in figure 41, each female type adapter comprises the little protuberance 146 of flexible locking, this is locked little protuberance and produces displacement by plug connector, and in case two relative edge of wound are drawn close fully, promptly locks the lateral projections 148 of plug connector 142.In case two relative needle stands are locked in together, the main body of skin extending apparatus can be taken away from wound area, only stays the needle stand of keyed at this place, as shown in figure 40.This can improve near the wound area of skin extending apparatus, for sewing up passage and the visuality that this regional skin edge is used.

Figure 43～46 expression skin closure devices 200 " another preferred embodiment, this device can comprise retainer 70,70 ' and be used to apply a screw mandrel 82 of skin pulling force.Each retainer can comprise a pivot pedestal or needle stand 150 again, this needle stand can comprise that at least one is contained in the integrally-regulated tooth bar 152 of the parallel inner surface of needle stand, at least one is positioned at the lateral groove 154 of each needle stand as shown in figure 43, and the pin shuttle 160 of a removable position in the needle stand body.Each pin person of outstanding talent 160 can comprise and a plurality ofly penetrates into part 23 by existing means location and fixed skin, and at least one integrally-regulated button 162, and this button can be in shuttle body in-plane direction location relatively, and can with 164 whole linking to each other of a shaped resilient deflection ratchet.The location of pin shuttle can move freely it along the straight path that is parallel to the longitudinal axis of screw mandrel in the needle stand body.The straight path length system of pin shuttle is limited by being contained in the lateral groove of pedestal.Skin penetrates into part 23 and can regulate button 162 and realize variable adjustment by depressing, as shown in figure 45, will be on side channel 154 the inside roof pressure of adjusting button of projection, and make ratchet 164 and regulate tooth bar and throw off, thereby but make pin shuttle 160 side channels move adjusting.Unclamp the adjusting button ratchet is engaged automatically with regulating tooth bar, thereby prevent sliding stop, and reorientate for the pin shuttle provides reliably in the needle stand body.

According to this preferred embodiment, needle stand 150 comprises a hollow needle stand body, along on this needle stand body two opposite sides inner surface the adjusting tooth bar 152 that is connected as a single entity being arranged.In addition, have parallel co-planar groove 154 in the both side surface of needle stand body, as shown in figure 43.Be contained in pin shuttle 160 in the inner chamber that defines by the needle stand body and comprise that a plurality of skins that are contained in its front surface penetrate into the integrally-regulated button 162 of part 23, side channel 154 projectioies by being arranged in the needle stand body and regulate the whole elastic deflection ratchet 164 that links to each other of button with each.The mobile adjusting that skin penetrates into part 23 can be clamped skin and be penetrated into cell tissue between part and the needle stand, thereby makes pin avoid forwarding to the skin outside when applying high virial.

The another preferred embodiment of Figure 47～49 expression skin closure device retainers 70, this retainer can comprise that a plurality of skins insert pin 23 and and are used for the device that protecting skin is inserted pin.According to this embodiment, preventer 170 can comprise the flexible piece 170a of an approximate horizontal, and this flexible piece comprises a flange 172 that extends with respect to its upper surface with acute angle from its leading edge.Flexible piece 170a comprises a plurality of from retainer 70 cannelures 174 that protrude, corresponding every pin 23, and each groove extends with respect to preventer leading edge approximate vertical.Pin 23 passes groove 174 so that needle point 23a stays preventer flange 172 back.The trailing edge of preventer can be contained on the retainer 70 neatly by any existing common means.

According to this preferred embodiment, preventer 170 has one to be essentially L shaped cross section, comprises a level of flexibility part 170a and an approximate vertical part 170b.Vertical member 170b is connected in bending part 170c integral body with horizontal element.Vertical member 170b is fixed on the dorsal part of retainer 70.This layout of preventer and retainer can make apparatus of the present invention not run into the pin that is exposed near cell tissue and protection user.For near cell tissue, pin and preventer are pressed to skin, and this makes automatically on the preventer partially, even pin can penetrate cell tissue like this.

The another preferred embodiment of the retainer 70 of Figure 50～52 expression skin closure devices, this retainer comprise can with bonded pedestal of the preventer that exposes pin 23 of skin closure device or needle stand 71.According to embodiments of the invention, preventer can comprise the protective cover 176 of hollow independently, and this protective cover comprises that at least one handles knob 177 and a Monolithic spring 178 extending from the upper surface of the protective cover 176 of hollow along the configuration of protective cover side.In addition, the protective cover of hollow can comprise that also at least one is used for the pin that engages slidably with the corresponding groove 181 of needle stand 71 pedestals 180 and at least one and is used for the little protuberance 182 of locking that engages slidably with the track 183 on a surface that is formed in needle stand 71.

A preferred embodiment of this device comprises the protective cover 176 of a hollow, and this protective cover has a downward inclined surface that forms preceding protection coating 184, and the upper surface of the approximate horizontal of the protective cover of this surface and hollow forms acute angle.What protective cover comprised that the integral body of two balanced configurations on two outer surfaces of protective cover of hollow connects handles knob 177.And Monolithic spring 178 is from protective cover upper surface horizontal-extending, and engages with the needle stand upper surface, in case and provide recuperability at protective cover when the orbit determination road moves along giving.The protective cover of hollow also comprises two pins 180, and each pin is along a relative inner face of the protective cover of hollow location and centering, each pin 180 all be formed in needle stand 71 each side on groove 181 engage slidably.This layout can make protective cover be installed on the needle stand securely, the pin 180 of protective cover can move to the other end from an end of groove like this, thereby make protective cover return or engage, the protective cover of hollow comprises that also two global formations lock little protuberance 182, and each is locked little protuberance and forms along a relative inner face of the protective cover of hollow.Each is locked little protuberance 192 and all slidably is contained in the track 183 that is formed on the needle stand respective side surface, to return and to change the protective cover that guides hollow in the operating process.

To handle knob and 177 just unclamp the protective cover lock, and shown in Figure 52, so just make pin 180 move to the rear portion of groove 181, and will lock little protuberance 182 and aim at the top of track 183 to pusher.This position will make protective cover can rotate around pin 180 when track 18 moves at the little protuberance 182 of locking.This motion penetrates into part 23 with skin and exposes to draw close cell tissue.When protective cover when upwards pin is exposed in upset, its whole returning spring 178 is tensioning.When device when cell tissue is taken out, returning spring automatically covers on protective cover on the pin downwards.Drawing handles knob 177 has just locked protective cover forward.

In case with needle stand from cell tissue shift out, automatically and the protective cover that can lock return, the protective cover protection user of hollow does not penetrate into part with the skin that exposes and collides.

The another embodiment of the rotary type lock 185 that Figure 53-55 expression skin closure device is used.According to this embodiment of the invention, retainer 70 ' can comprise is used for releasably retainer 70 ' the be locked at lock of one on the screw 82 185.Retainer 70 ' comprise a unthreaded hole, so that retainer 70 ' along the longitudinal axis freely-movable of screw 82.Rotary type lock 185 comprises a threaded portion 187, it can lock retainer, with the threads engage of screw mandrel 82.Also can will lock biasing by the resilience of selected materials, lock just can be parked in closed or open position like this.In addition, rotary type lock can comprise a latch 189 and a unstick 191 that can the rotary type lock be unclamped from bonding station by user that is used for the rotary type locking is fixed on a closed position.

According to this preferred embodiment, the fixing and design of rotary type lock 185 makes it can be by the pivot pin 193 and retainer 70 ' rotational engagement at a rotary middle point.Retainer comprises the little protuberance 195 of integral locking of accepting the whole latch 189 of also fastening rotary type lock 185 when lock is in the closed position.One inner surface portion of rotary type lock 185 comprises and the profile of screw mandrel 82 couplings and a profile and the interior threaded surface 187 of screw thread specification.When rotary type is locked when in the closed position, shown in Figure 55, interior threaded surface 187 guarantees retainer and screw mandrel 82 screw-threaded engagement.When the rotary type lock is shown in an open position, shown in Figure 54, retainer 70 ' unclamp, and can move along driving screw mandrel 82.

As the major advantage that this arrangement results embodied is except tension rail being engaged rapidly or when throwing off accurately the self-aligned, can also providing positive closure.For example, lock can be opened by unstick 191 is mentioned rapidly and easily, and this makes rotary type lock 185 deflection and make latch 189 throw off the little protuberance 195 of integral lockings a little.Continuation along being rotated counterclockwise rotary type lock 185, shown in Figure 54, makes the profile of rotary type lock 185 and screw-threaded engagement surface 187 throw off with the screw thread on the tension rail 82 around bearing pin 193.On the contrary, can rotate counterclockwise unstick and close or engage this lock, shown in Figure 55, automatically engage the little protuberance 195 of locking up to latch 189, make the interior profile of rotary type lock 185 and screw-threaded engagement surface 187 secure engagement and on its axis mobile a little screw thread tension rail 82, thereby realize self-aligned.

The preferred embodiment of pin between Figure 56 and 57 expression skin skins, it includes a cross section of three seamed edges or five seamed edges.Pin 120 includes a d-axis 211 that has the sharp 211a of an awl between each skin.

According to preferred embodiment, pin system is made of a steel with surgery between skin.D-axis can be connected on the one handle 212 that comprises an offset part 213.This handle can be connected by bonding or welding with axle.The biasing handle is convenient to pin manipulation and insertion between the skin skin.One protective cover 220 can be provided.Protective cover can comprise alar part or extension 221, so that protective cover is unloaded from pin between the skin skin.

Figure 58 and 59 expressions have the preferred embodiment of the skin extending apparatus of protective cover 230.According to this preferred embodiment, provide blister pack so that user can see that skin penetrates into part.Protective cover also can protecting skin penetrate into part in carrying and loading process.But also can protect the doctor to preserve from.

Figure 60 represents compensator used on the skin closure device 240.Compensator is preferably identical with the length of skin extending apparatus, and strengthens layout and the aligning of this device at the skin injury circumference.Compensator should have the atraumatic end 241,242 of curved edge 243.

This device also can adopt blunt nosed pin or hook to replace skin to penetrate into part.An available sharp object stabs out skin.The blunt nosed cushion of retainer can be entered stab out the zone then.Blunt nosed needle construction provides a security feature, because surgeon may be penetrated into the part incised wound by skin, and is infected by patient's body fluid.The use of this device and this device is all same as the previously described embodiments in others.

According to this preferred embodiment, the polycarbonate that screw mandrel system is filled by 30% glass fibre and 15% politef is made.Indicator and axle bush are made by polyamide (nylon) 6/6.Pin is made with rustless steel by surgery between skin insert and skin skin, and all other parts are then made by " Lexan " polycarbonate.

In a word, this device thinks over should be used as under broad wound or skin injury situation.A big wound may be caused and may be needed by gunslinging, different wound, surgical operation or cancers to be removed.After the edge slit that will need in addition closed big wound, surgeon can insert pin between two skin skins in the opposite edges of skin where necessary.

Next, the surgeon can be placed on two retainers the two opposite sides of wound, simultaneously the skin insert is hooked in the arbitrary end below the pin between the skin skin.Should note pin between the skin skin can being inserted than skin layer depths more, promptly insert fascia.And should notice that two retainers can shed, and ressembled subsequently before wound circumference is arranged before drawing close.In case hook the two ends of a retainer, surgeon can be combined these two ends soon, up to the resistance of the closed cell tissue that runs into some.

But can go into the regurgitation snap close threaded portion of locking this moment, so that connect retainer with threads engage.Surgeon can begin turning knob and apply pulling force, up to reaching by the indicated recommendation power of the numeral of one on the power level indicator scale.

Comprise that at the skin extending apparatus local engagement part rather than skin penetrate into the occasion of part or skin insert, can be placed on wound circumference to the skin closure device earlier, thereby pin between local engagement part and skin can be engaged so that retainer is configured in two relative edge's edge of wound.Pin is inweaved skin between skin, outstanding skin, and the local engagement part by extending from first shank inweaves skin, outstanding skin, and a local engagement part by extending from second shank, and inweave skin once more.In case all local fasteners all with skin between the corresponding exposed portions serve of pin engage, surgeon can pool together two retainers soon, up to the resistance of the closed cell tissue that runs into some.Then but the regurgitation snap close can be gone into the threaded portion of locking, so that connect retainer with threads engage.Then to the contract application of force, by a limit power part edge of skin injury is no more than one and gives and decide power towards the another side marginal zone is moving, the wound two edges are drawn close.

On the other hand, be the occasion of a local engagement part such as groove 126 or clip 125 at the skin engagement part, at first pin between skin can be knitted by skin and be compiled so that can see its some.The skin extending apparatus can be placed on wound circumference then, so that the local engagement part is configured near pin exposed portions serve between skin.Then the exposed portions serve of pin between skin is passed local engagement part split shed separately, can engage pin between skin.In case all local fasteners all with skin between the exposed portions serve separately of pin engage, surgeon can be combined two ends soon, until the resistance that runs into a certain amount of closed cell tissue.Then but the regurgitation snap close can be gone into the threaded portion of locking, so that connect retainer with threads engage.Surgeon can begin turning knob, and applies pulling force, until reaching by the indicated recommendation power of the graduated numeral of power level indicator.

Realize under surgeon is rotated further the situation of knob even an advantage of the invention is.Applied force is a greatest level, and can not surpass.Because clutch has been thrown off, so power can not increase.In applying the process of power, spring compresses, and retainer is then pooled together.Indicator is moved along scale, and surgeon can be estimated the process that applies of increase power.

The inventor notices also available ocular estimate when spline is thrown off, because indicator no longer moves to higher value.Surgeon also accepts more not apply the tactile feedback of power.This device is self regulation in this respect.According to preferred embodiment, it is the Hook's spring constant that the skin extending apparatus has a certain constant spring ratio.The viscoelasticity of skin allows skin to stretch, and compressed spring has then stretched when getting back to its original resting position basically.

Retainer also stretches starting simultaneously with spring, and indicator for displaying power grade reduces.The indicator for displaying amount of movement, therefore an observer can see that this device is still in work.Clutch also engages again so that surgeon can carry out other skin and stretches operation.These operations are repeated in the compartment of terrain, up to skin also together.Spring and power restriction are greatly being controlled and are being stretched operation.When cutis laxa, this device is got back to its original resting position substantially.Be easy to estimate the stretching, extension of skin and relax.This device function such as same feedback system in this respect.

Also can consider to adopt this device to come a closed skin area for the large tracts of land wound, should sew up in the zone, and this device is reorientated at this wound another part or at another wound of same patient.Also can consider single patient or single wound are adopted multiple arrangement simultaneously.

The expression by way of example of above illustrated embodiment system.Spirit of the present invention and scope then are not subjected to the restriction of above-mentioned preferred embodiment.

Claims (103)

1. skin injury closing device, it comprises:

Be used for engaging the device of skin along the opposite edges of a skin injury;

Be used for device that described skin injury opposite edges are drawn close;

Be used to limit the device of a power that applies along the skin injury edge; And

Be used to make skin closure device and skin injury edge to keep aligned device.

2. skin injury closing device as claimed in claim 1 is characterized in that described restraint device comprises that one is connected to the described clutch of drawing close device, so drawn close the power that device applies along the skin injury edge and be limited in a predetermined value by described.

3. skin injury closing device as claimed in claim 2 is characterized in that, described clutch comprises:

A positive external component that comprises a single spline that radially extends; And

Comprise a plurality of radial spline and define the endoporus fastener that the groove of described external component is accepted in a design.

4. skin injury closing device as claimed in claim 3 is characterized in that, each described spline includes an inclination contact surface.

5. skin injury closing device as claimed in claim 1 is characterized in that, described engagement device comprises:

Be used for along pin between many root bark skin of described skin injury opposite edges insertion skin, as seen its longitudinal component at least that is designed to pin between each described skin is, and

Be used for skin between a plurality of local engagement parts of engaging of pin visible part.

6. skin injury closing device as claimed in claim 5 is characterized in that, described local engagement part is an annular distance.

7. skin injury closing device as claimed in claim 5 is characterized in that, described local engagement part is a seam (suture).

8. skin injury closing device as claimed in claim 5 is characterized in that, described local engagement part is a clip.

9. skin injury closing device as claimed in claim 5 is characterized in that, described local engagement part is the end that is designed to the shank of an aperture or groove shapes.

10. skin injury closing device as claimed in claim 1 is characterized in that, described maintenance alignment device comprises:

A plurality of retainers, each described retainer include a substrate and have and are connected to one first end on the described substrate and are connected to the described flange of drawing close second end of 1 on the device;

A plurality of needle stands, each described needle stand all is connected to described substrate surface in the mode of swaying, and comprises a plurality of skin inserts.

11. skin injury closing device as claimed in claim 1 is characterized in that, described engagement device comprises:

Comprise one first retainer of one first substrate, described first substrate comprises:

A plurality of skin inserts, each described skin insert all protrude from a surface of described first substrate;

The external component that at least one protrudes from a surface of first substrate; And

Comprise one second retainer of one second substrate, described second substrate comprises:

A plurality of skin inserts, each described skin insert all protrude from a surface of described second substrate;

The endoporus fastener that at least one protrudes from a surface of second substrate, described endoporus fastener are designed to promptly accept and fix described external component in case described retainer is drawn close fully.

12. skin injury closing device as claimed in claim 11 is characterized in that, described first substrate is detachably connected on described first retainer, and described second substrate is detachably connected on described second retainer.

1 3. skin injury closing devices as claimed in claim 1 is characterized in that, but described engagement device by demolition be connected to described drawing close on the device.

14. skin injury closing device as claimed in claim 1 is characterized in that described engagement device comprises a plurality of retainers, each retainer comprises:

The needle stand body of one hollow; And

One is configured in the pin shuttle in the needle stand body of described hollow slidably, and described pin shuttle comprises a plurality of skin inserts that protrude from a surface of described pin shuttle.

15. skin injury closing device as claimed in claim 1 also comprises the device that a plurality of skin inserts that are contained on the described engagement device are protected, described engagement device comprises the substrate of described a plurality of skin insert from a surface of its extension.

16. skin injury closing device as claimed in claim 15, it is characterized in that, described preventer comprises that one is roughly planar scalable protective cover, and this protective cover has one first end that is fixed on the described substrate and includes one second end with respect to a flange of the upper surface extension in an acute angle of described protective cover.

17. skin injury closing device as claimed in claim 15 is characterized in that, described preventer comprises that a telescopically is connected on the described substrate and is designed to cover the protective cover that a plurality of skins insert the hollow of pins.

18. a skin injury closing device comprises:

A plurality of retainers, each described retainer comprises:

At least two shanks,

Connect described shank and comprise a flange of the flange hole between described shank,

A plurality of local engagement parts, each described local engagement part are from a surface of a described shank and protrude; And

A contracting mechanism that connects described retainer and engage with a described flange hole; Described contracting mechanism is designed to draw close described retainer.

19. skin injury closing device as claimed in claim 18 also comprises, being used for engaging with described local engagement part so that the some parts of pin is configured in the skin surface top between described skin along pin between many root bark skin of wound opposite edges insertion skin.

20. skin injury closing device as claimed in claim 19, it is characterized in that, pin is woven by skin between a plurality of skins, and pin exposes skin at least twice between described like this skin, thus the fastener that protrudes from each shank of retainer can and skin between the pin local engagement.

21. skin injury closing device as claimed in claim 18 is characterized in that, each described retainer all is designed so that described shank parallel alignment.

22. skin injury closing device as claimed in claim 18 is characterized in that, each described local engagement part includes an annular distance.

23. skin injury closing device as claimed in claim 18 is characterized in that, each described local engagement part includes a seam (suture).

24. skin injury closing device as claimed in claim 18 is characterized in that, each described local engagement part includes a clip.

25. skin injury closing device as claimed in claim 18 is characterized in that, each described local engagement part includes an aperture or a groove that is configured in the end of shank.

26. a skin injury closing device comprises:

A plurality of retainers, each described retainer comprises:

One substrate,

Be connected to described substrate and comprise a flange of a recessed marginal pore,

A plurality of skins insert individual, and each described skin insert is from a surface of described substrate and protrudes, and

A contracting mechanism that connects described retainer and engage with a described flange hole, described contracting mechanism is designed to draw close described retainer.

27. skin injury closing device as claimed in claim 26 is characterized in that, described substrate also comprises:

Substrate with upper surface of a lower surface that is connected to described flange; And

One is connected to needle stand on the described substrate in the mode of swaying, and described needle stand comprises two shanks.Each described skin insert all protrudes from a surface of a described shank.

28. skin injury closing device as claimed in claim 27 is characterized in that, described substrate also comprises described substrate is connected to rotary type connector on the described needle stand.

29. skin injury closing device as claimed in claim 28 is characterized in that, described substrate, described needle stand and described rotary type connector comprise a monoblock unit.

30. skin injury closing device as claimed in claim 26 is characterized in that, described a plurality of retainers comprise:

Include one first retainer of one first substrate, described first substrate comprises an external component that protrudes from first substrate, one surface again at least; And

Include second retainer of one second substrate, described second substrate comprises an endoporus fastener that protrudes from second substrate, one surface again at least, and described endoporus fastener is designed to promptly accept and fix described external component in case described retainer is drawn close fully.

31. skin injury closing device as claimed in claim 30, it is characterized in that, described first substrate also comprises the endoporus fastener that protrudes from a surface of described first substrate, and described second substrate comprises that also an external component that protrudes from a surface of described second substrate, the described endoporus fastener of described first substrate are designed in case described retainer is drawn close the described external component of promptly accepting and fixing described second substrate fully.

32. skin injury closing device as claimed in claim 30 is characterized in that, described first substrate is detachably connected to a flange of described first retainer, and described second substrate is detachably connected to a flange of described second retainer.

33. skin injury closing device as claimed in claim 26 is characterized in that, but described substrate by demolition be connected to described flange.

34. skin injury closing device as claimed in claim 33, it is characterized in that, described flange comprises a double pointed nail that protrudes from flange one surface, and described substrate comprises a surperficial joining base hole of going up, being used for removably accepting described double pointed nail that is formed on substrate.

35. skin injury closing device as claimed in claim 26 is characterized in that, described substrate comprises:

The needle stand body of one hollow, and

-being configured in the pin shuttle in the needle stand body of described hollow slidably, described a plurality of skin inserts system protrudes from a surface of described pin shuttle.

36. skin injury closing device as claimed in claim 35 is characterized in that, the needle stand body of described hollow comprises:

At least one is along the adjusting tooth bar of each lateral surface configuration of the needle stand body of described hollow; And

At least one groove that forms in each described lateral surface of the needle stand body of described hollow.

37. skin injury closing device as claimed in claim 36 is characterized in that, described pin shuttle comprises:

At least one spring deflection ratchet, each all is designed to releasably engage with a described adjusting tooth bar at least, and

At least one regulates button, each all is connected to a described spring deflection ratchet at least, and extend by a groove in the needle stand body of described hollow at least, described adjusting push-button design is for unclamping a described spring deflection ratchet that engages with described at least one adjusting tooth bar at least according to the action of regulating button.

38. skin injury closing device as claimed in claim 26 also comprises:

Be contained on each described retainer and be designed to protect the flexible protective cover at described skin insert tip.

39. skin injury closing device as claimed in claim 38, it is characterized in that, described flexible protective cover comprises on one planar member and is contained on the planar member and a vertically extending lower planar member substantially with it, and the protective cover that should stretch have a roughly L shaped cross section.

40. skin injury closing device as claimed in claim 39 is characterized in that, the described planar member system of going up is fixed on the described retainer.

41. skin injury closing device as claimed in claim 39 also comprises from a free end of the described lower planar member integral-type flange with respect to the upper surface extension in an acute angle of described protective cover, and is designed to protect described skin insert tip.

42. skin injury closing device as claimed in claim 39 is characterized in that, described lower planar member comprises a plurality of parallel slots that are used to accept described skin insert.

43. skin injury closing device as claimed in claim 26 is characterized in that described contracting mechanism comprises a screw mandrel at least.

44. skin injury closing device as claimed in claim 43, it is characterized in that, described retainer comprises the rotary type lock that has a locking screw spare at least, and is designed to that described locking screw spare engages with described screw when being in a locked position when described rotary type is locked.

45. skin injury closing device as claimed in claim 26 also comprises the rotation protective cover that is connected to the hollow on the described substrate, and is designed to protect when in the closed position described skin insert.

46. skin injury closing device as claimed in claim 45 is characterized in that, the rotation protective cover of described hollow comprises:

At least include a protecting cover of a downward inclined surface that is connected to a upper surface, described upper surface is configured in a upper surface of described substrate slidably;

A whole spring that forms that extends from the described upper surface of described protecting cover;

At least one monolithic molding pin, each pin are from a medial surface of described protection body and protrude, and be designed to described substrate one lateral surface on a respective slot engage slidably; And

The little protuberance of at least one global formation, each little protuberance all protrude from the medial surface of described protecting cover, and the corresponding sliding rail that is designed to slidably on the described side surface with described substrate engages.

At least one is handled knob, and each is handled knob and all is configured in a lateral surface of described protecting cover.

47. skin injury closing device as claimed in claim 26 is characterized in that, described contracting mechanism includes a clutch that is designed to be limited in by the power that described contracting mechanism applies along the skin injury edge predetermined value.

48. skin injury closing device as claimed in claim 47 is characterized in that, described clutch comprises that an external component and defining is designed to accept an endoporus fastener of the groove of described external component.

49. skin injury closing device as claimed in claim 48 is characterized in that, described external component comprises a spline that radially extends, and described endoporus fastener comprises a plurality of corresponding radial splines.

50. skin injury closing device as claimed in claim 49 is characterized in that the distance between described retainer has been stipulated an axis, described endoporus fastener is designed to an axial stationary engagement part, and described external component is designed to an axially movable fastener.

51. skin injury closing device as claimed in claim 50 is characterized in that, each described fastener includes an inclination contact surface.

52. skin injury closing device as claimed in claim 50 is characterized in that, described clutch also comprises a biasing member that is designed so that described axially movable fastener is setovered to described axial stationary engagement part.

53. a skin injury closing device, it comprises:

At least two retainers, each described retainer include a plurality of skin inserts that insert skin along the skin injury edge;

One connects described retainer and comprises the contracting mechanism of a clutch, and the power that described clutch designs becomes to be applied along the skin injury edge by described contracting mechanism is limited in a predetermined value.

54. skin injury closing device as claimed in claim 53 is characterized in that, described contracting mechanism comprises a plurality of substantially parallel aligned constrictor arms, and each described constrictor arm is all with described retainer of sliding type supporting.

55. skin injury closing device as claimed in claim 54 is characterized in that, each described constrictor arm at one end includes a smooth straight-bar, and each described retainer also comprises and is designed so that the retainer support holes of described constrictor arm by wherein.

56. skin injury closing device as claimed in claim 54 is characterized in that, a described constrictor arm comprises a constrictor arm smooth hole, and another described constrictor arm comprises a constrictor arm screw.

57. skin injury closing device as claimed in claim 56 also comprises a screw that connects described constrictor arm and comprise a threaded portion that engages with described constrictor arm screw.

58. skin injury closing device as claimed in claim 56 is characterized in that, each described constrictor arm comprises a plurality of beads, and each described bead defines a described constrictor arm hole.

59. skin injury closing device as claimed in claim 54 also comprises a cylindrical bar, it is characterized in that, each described constrictor arm also comprises a mating holes; Described cylindrical bar extends by described mating holes.

60. skin injury closing device as claimed in claim 53 is characterized in that, each described retainer includes the flange that is connected and defines a flange hole with described shank, and described flange hole comprises and the aligned axis of the axis almost parallel of described shank.

61. skin injury closing device as claimed in claim 60, it is characterized in that, one in the described flange hole is a flange screw, and another in the described flange hole is a flange unthreaded hole, and described contracting mechanism comprises a screw that extends by described flange hole at least.

62. skin injury closing device as claimed in claim 53 is characterized in that, described at least two retainers also comprise two U-shaped retainers, and each described U-shaped retainer comprises two shanks and a flange that is connected described shank.

63. skin injury closing device as claimed in claim 53 also comprises pin between the many root bark skin that is engaged by described skin insert.

64., it is characterized in that pin comprises pin between two skins between described a plurality of skins as the described skin injury closing device of claim 63.

65. skin injury closing device as claimed in claim 53 is characterized in that, described clutch is a friction clutch.

66. skin injury closing device as claimed in claim 53 is characterized in that, described clutch is a friction clutch.

67. skin injury closing device as claimed in claim 53 is characterized in that, described clutch comprises that a splined shaft and defining is designed to accept a splined hole of the groove of described splined shaft.

68. skin injury closing device as claimed in claim 53, it is characterized in that, distance between described retainer has been stipulated an axis, described clutch comprises a plurality of splines, one of described spline is designed to an axial static spline, and another of described spline is designed to an axially movable spline.

69., it is characterized in that each in the described spline includes an inclination contact surface as the described skin injury closing device of claim 67.

70. skin injury closing device as claimed in claim 53 also comprises a power level indicator that is connected to described contracting mechanism and is used to indicate the power that applies along the skin injury edge.

71. a skin injury closing device, it comprises:

A plurality of retainers, each described retainer comprises:

At least two shanks,

Connect described shank and comprise a flange that is positioned at the flange hole between described shank,

A plurality of skin inserts, each described skin insert evenly protrude from a surface of a described shank, and

A contracting mechanism that connects described retainer and engage with a described flange hole, described contracting mechanism is designed to draw close described retainer.

71., it is characterized in that each described retainer all is designed to make described shank parallel alignment as the described skin injury closing device of claim 70.

72. as the described skin injury closing device of claim 70, also comprise pin between two skins, pin all is designed for to insert and draws close under the skin at skin injury edge between each described skin, each described skin insert all with a described skin between pin engage.

73., it is characterized in that described a plurality of retainers comprise two retainers as the described skin injury closing device of claim 70.

74., it is characterized in that each described skin insert is a skin and penetrates into hook as the described skin injury closing device of claim 70, described a plurality of skins penetrate into hook and comprise that two skins penetrate into hook.

75., it is characterized in that described contracting mechanism comprises a screw at least as the described skin injury closing device of claim 70.

76., it is characterized in that one of described flange hole is the flange screw as the described skin injury closing device of claim 75, described screw engages with described flange screw.

77. as the described skin injury closing device of claim 75, it is characterized in that, one of described retainer flange hole is a unthreaded hole, and described screw comprises and be designed to the axle sleeve that contacts with the described retainer that described unthreaded hole is arranged that described screw extends by described unthreaded hole.

78. as the described skin injury closing device of claim 75, it is characterized in that, but of described retainer comprise the regurgitation lock that has a locking screw spare at least and be designed so that described locking screw spare engages with described screw when but described regurgitation lock be in locked position.

79., it is characterized in that described at least two retainers also comprise two U-shaped retainers as the described skin injury closing device of claim 70, each described U-shaped retainer includes two shanks and a flange that is connected with described shank.

80. as the described skin injury closing device of claim 70, also comprise pin between a plurality of skins, pin is designed to make that pin engages between described retainer and described skin between described skin when described contracting mechanism is drawn close described retainer.

81., it is characterized in that pin comprises pin between two skins between described a plurality of skins as the described skin injury closing device of claim 80.

82. as described in claim 80, the skin injury closing device is arranged, it is characterized in that each between described each skin in the pin includes one handle and be connected to needle shaft between skin always on the described handle.

83. as described in claim 82, the skin injury closing device is arranged, it is characterized in that, described handle comprise and described straight skin between the part of needle shaft biasing.

84., also comprise a power level indicator that is connected to described contracting mechanism and is used to indicate the power that applies along the skin injury edge as the described skin injury closing device of claim 70.

85., it is characterized in that described power level indicator comprises a plurality of numerals as the described skin injury closing device of claim 84, described each numeral is all represented the different brackets of the power that applies along the skin injury edge.

86., it is characterized in that described contracting mechanism comprises that the power that is designed to be applied along the skin injury edge by described contracting mechanism is restricted to a clutch of a predetermined value as the described skin injury closing device of claim 70.

87., it is characterized in that described clutch is a friction clutch as the described skin injury closing device of claim 86.

88., it is characterized in that described clutch comprises that a splined shaft and limits a splined hole of the groove be designed to accept described splined shaft as the described skin injury closing device of claim 86.

89. as the described skin injury closing device of claim 86, it is characterized in that, distance between the described retainer has been stipulated an axis, described clutch comprises a plurality of splines, one in the described spline is designed to an axial static spline, and another in the described spline is designed to an axially movable spline.

90., it is characterized in that each described spline includes an inclination contact surface as the described skin injury closing device of claim 89.

91., it is characterized in that described clutch also comprises and is designed to make the biasing member of described axially movable spline to described axial static spline offset as the described skin injury closing device of claim 89.

92., it is characterized in that each described retainer includes a rotary type substrate that is designed to make the reference position rotation of described substrate on described retainer as the described skin injury closing device of claim 70.

93., it is characterized in that each described retainer also comprises the link stopper that the described rotary type substrate of restriction rotatablely moves as the described skin injury closing device of claim 92.

94. as the described skin injury closing device of claim 92, it is characterized in that, described rotary type substrate also be designed to make described substrate around the reference position of described retainer from about 0 ° rotate to approximately ± 20 °.

95. the method for the broad skin injury of closure, it may further comprise the steps:

Retainer is located in the skin injury opposite edges;

Pin between skin is inserted skin along described skin injury opposite edges, and engage with described retainer;

, do not exceed to give so that an edge of skin injury is drawn close towards another edge of skin injury and decide power a contracting mechanism application of force by a limit power part.

96. the method as the broad skin injury of the described closure of claim 95 is characterized in that, the step of inserting pin between skin is further comprising the steps of:

Go into skin with knitting between skin, pass skin, one first local fastener by a described retainer enters skin again, and outstanding skin, and one second local fastener by a described retainer enter skin again.

97. the method as the broad skin injury of the described closure of claim 95 is characterized in that, the step of inserting pin between skin is further comprising the steps of:

Go into skin with knitting between skin, outstanding skin enters skin again, and outstanding again skin enters skin again;

The exposed portions serve of pin between skin is engaged with a plurality of local engagement parts that extend from a surface of each described retainer.

98., further comprising the steps of as the method for the broad skin injury of the described closure of claim 95:

Shown in the drop-out value on the power level indicator, observe cutis laxa, and

Again to the contracting mechanism application of force, so that pin engages between retainer and skin, and give when deciding the power grade in power level indicator indication one, an edge of skin injury is drawn close towards another edge of skin injury.

99. the method for the broad skin injury of closure, it may further comprise the steps:

Pin between skin is inserted skin along the skin injury edge;

Retainer is located adjacent near the skin injury of pin between skin;

To a contracting mechanism application of force,, do not decide power by a limit power part and do not exceed to give so that pin engages between retainer and skin, and draws close an edge of skin injury towards another edge of skin injury.

100. the method as the broad skin injury of the described closure of claim 99 is characterized in that, near the described step that retainer is located adjacent to the skin injury of pin between skin is further comprising the steps of:

Penetrate into part and penetrate into skin with being contained in skin on the retainer, with the retainer location down near the step the skin injury penetrate into skin simultaneously.

101. the method as the broad skin injury of the described closure of claim 99 is characterized in that, near the described step that retainer is located adjacent to the skin injury of pin between skin is further comprising the steps of:

Penetrate into part with skin and penetrate into skin; And

The skin insert that is contained on the retainer is being penetrated into the skin area location.

102., further comprising the steps of as the method for the broad skin injury of the described closure of claim 99:

Shown in the drop-out value on the power level indicator, observe cutis laxa, and

Again to the contracting mechanism application of force, so that pin engages between retainer and skin, and indication one is given when deciding the power grade on the power level indicator, and an edge of skin injury is drawn close towards another edge of skin injury.

Images